Treatment of Autoimmune Diseases Using Noble Gas Mixtures

ABSTRACT

The invention disclosed provides means of inhibiting, ameliorating, and/or treatment of rheumatoid arthritis through the use of Noble gas containing mixtures. In one embodiment, the invention provides means of reducing inflammation and immune associated pathology through administration of Noble gas mixtures. In one specific embodiment, Xenon gas is administered to a patient in need at concentrations and frequencies sufficient to inhibit inflammatory and autoimmune processes. In another embodiment Noble gas mixtures are administered to reduce pain and provide symptomatic relieve to a patient suffering from rheumatoid arthritis. In another embodiment the use of Noble gas containing mixtures is disclosed as a means of reducing joint destruction through inhibition of matrix metalloprotease production and activity.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present invention claims priority to and is a continuation ofpending U.S. Non-Provisional application Ser. No. 15/628,371, filed Jun.20, 2017, which claims priority to U.S. Provisional Application No.62/352,497, filed Jun. 20, 2016, both of which are hereby incorporatedin their entireties including all tables, figures, and claims.

FIELD OF THE INVENTION

The invention pertains to the field of autoimmunity, more specifically,the invention pertains to the use of utilization of Noble gases totreated rheumatoid arthritis, more specifically the invention pertainsto the use of gaseous compositions, in some embodiments, xenon-gascontaining composition to reduce pain and inflammatory/autoimmunityprocesses subside.

BACKGROUND

Autoimmune diseases are characterized by an excessive reaction of theimmune system against endogenous tissue. The immune system erroneouslyrecognizes endogenous tissue as foreign bodies to be combated. Thisresults in severe inflammatory reactions, which lead to damage to organsaffected by them. An important part in distinguishing between endogenousand exogenous structures is played by T lymphocytes or T cells, whichare “trained” in the thymus to dock only onto endogenous cell surfacemolecules, the so-called MHC molecules, and thus to tolerate endogenousstructures. These processes are called “clonal deletion” and “clonalselection”. During the initial selection in the thymus, only those Tcells, which are able to recognize WIC molecules on the endogenous cellmembranes survive, while the binding is however not so strong that itcould lead to activation of the T cells. T cells which cannot bind to orrecognize endogenous WIC molecules at all are eliminated. In the clonaldeletion also taking place in the thymus, those T cells which are ableto “unerringly” recognize and strongly bind endogenous WIC molecules insuch a manner that they would be activated, which would in the end leadto the destruction of endogenous cells, are eliminated. This process isone of those measures which the immune system takes in order to be ableto protect the “self” and combat the “exogenous”.

In autoimmune diseases, a group of the T cells behaves abnormally. Inaddition to the still functioning defense from exogenous molecules andorganisms, they now also attack endogenous structure. Organs or tissuesare perceived as exogenous. There can be various consequences: if vitalstructures are affected, an autoimmune disease will take a fatal course.The immune system directs its defense against these structures, cellularand also humoral defense reactions are set in motion, and autoantibodiesare formed, as a result of which the organs affected in the course oftime cease to function. Most commonly, the immune system is weakened andthe body becomes susceptible to all kinds of diseases. Under somecircumstances, recognition of the exogenous is also disrupted, and as aresult the spreading of degenerated cancer cells can no longer beeffectively prevented, and those affected are more susceptible toinfectious diseases. In the course of the disease, cells of the immunesystem destroy the endogenous structures, while the body's repairmechanisms attempt as far as possible to regenerate the damaged organparts. As a rule, without treatment this erroneous attack of thedefensive system continues throughout life or until the completedestruction of the target structure. Autoimmune diseases are treatedaccording to the organ affected. In this, the basic principle of thecausal therapy is to suppress the activity of the immune system byadministration of immunosuppressants, e.g., cortisone. These substancesare characterized by multiple systemic side-effects and interactions,owing to which attempts have been made to develop new drugs whichspecifically influence the mechanisms involved in the disease event.Examples of this are natalizumab and infliximab. Natalizumab is amonoclonal antibody and selective inhibitor of IgG4, an adhesionmolecule which is located on the surface of white blood cells.Natalizumab inhibits the migration of white blood cells intoinflammation foci and is used for the treatment of particularlyaggressive forms of plaque progressive multiple sclerosis. Infliximab isa chimeric monoclonal antibody against tumour necrosis factor .alpha.(TNF.alpha.), which plays a key part in autoimmune inflammatoryreactions. Infliximab is used in rheumatoid arthritis, Crohn's disease,and psoriasis.

SUMMARY OF THE INVENTION

Certain embodiments of the teachings herein are directed to methods ofinhibiting an autoimmune process, such as rheumatoid arthritis,comprising the steps of: a) obtaining a patient suffering from apathological immune response against self-antigens; b) providing to saidpatient a Noble gas composition; and c) adjusting dosage and frequencyof administration of said Noble gas composition based on immunologicaland/or clinical response.

Various aspects of the invention relating to the above are enumerated inthe following paragraphs:

Aspect 1. A method of inhibiting an autoimmune process comprising thesteps of: a) obtaining a patient suffering from a pathological immuneresponse against self-antigens; b) providing to said patient a Noble gascomposition; and c) adjusting dosage and frequency of administration ofsaid Noble gas composition based on immunological and/or clinicalresponse.

Aspect 2. The method of aspect 1, wherein said autoimmune process isrheumatoid arthritis.

Aspect 3. The method of aspect 2, wherein said rheumatoid arthritispatient is defined as suffering from at least one symptom of rheumatoidarthritis, the symptom selected from the group consisting of morningstiffness, painful joints, swollen joints, loss of grip strength, andpain.

Aspect 4. The method of aspect 1, wherein said autoimmune process isselected from a group comprising of: multiple sclerosis, rheumatoidarthritis, type 1 diabetes, Crohns disease, ulcerative colitis,psoriasis, celiac disease, Acute disseminated encephalomyelitis (ADEM),Addison's disease, Agammaglobulinemia, Alopecia areata, Amyotrophiclateral sclerosis, Ankylosing Spondylitis, Antiphospholipid syndrome,Anti synthetase syndrome, Atopic allergy, Atopic dermatitis, Autoimmuneaplastic anemia, Autoimmune cardiomyopathy, Autoimmune enteropathy,Autoimmune hemolytic anemia, Autoimmune hepatitis, Autoimmune inner eardisease, Autoimmune lymphoproliferative syndrome, Autoimmune peripheralneuropathy, Autoimmune pancreatitis, Autoimmune polyendocrine syndrome,Autoimmune progesterone dermatitis, Autoimmune thrombocytopenic purpura,Autoimmune uveitis, Behcet's disease, Celiac disease, Cold agglutinindisease, Crohn's disease, Dermatomyositis, Dermatomyositis, Eosinophilicfasciitis, Goodpasture's syndrome, Graves' disease, Guillain-Barresyndrome (GBS), Hashimoto's encephalopathy, Hashimoto's thyroiditis,Idiopathic thrombocytopenic purpura, Lupus erythematosus, Miller-Fishersyndrome, Mixed connective tissue disease, Myasthenia gravis,Narcolepsy, Pemphigus vulgaris, Pernicious anaemia, Polymyositis Primarybiliary cirrhosis, Psoriasis, Psoriatic arthritis, Relapsingpolychondritis, Rheumatic fever, Sjogren's syndrome, Temporal arteritis,Transverse myelitis, Ulcerative colitis, Undifferentiated connectivetissue disease, Vasculitis, and Wegener's granulomatosis.

Aspect 5. The method of aspect 1, wherein said Noble gas mixturecontains oxygen and a proportion by volume of 20 to 70% of xenon.

Aspect 6. The method of aspect 5, wherein said proportion of xenon isbetween 22 and 60% by volume to oxygen.

Aspect 7. The method of aspect 6, wherein said proportion of xenon isbetween 25 and 60% by volume to oxygen.

Aspect 8. The method of aspect 1, wherein said noble gas containingmixture consists only of a) oxygen and xenon or b) air and xenon.

Aspect 9. The method of aspect 1, wherein said noble gas containingmixture also contains nitrogen, helium, Nitric Oxide, krypton, argon orneon.

Aspect 10. The method of aspect 1, wherein said noble gas containingmixture contains a proportion by volume of oxygen of between 15 and 25%.

Aspect 11. The method of aspect 1, wherein said noble gas containingmixture is supplied for inhalation from a pressurized container at apressure greater than 2 bar.

Aspect 12. The method of aspect 1, wherein said noble gas containingmixture is administered intranasally.

Aspect 13. The method of aspect 1, wherein said noble gas containingmixture is administered through the use of a hyperbaric chamber.

Aspect 14. The method of aspect 13, wherein said hyperbaric chamber ispressurized to a pressure of no more than 3 atm (0.3 MPa).

Aspect 15. The method of aspect 14, wherein a noble gas is administeredto the patient while the patient is in the hyperbaric environment.

Aspect 16. The method of aspect 1 wherein said noble gas is administeredby inhalation or simulated inhalation.

Aspect 17. The method of aspect 1, wherein said noble gas is xenon,helium, or a mixture of xenon and helium.

Aspect 18. The method of aspect 1, wherein the noble gas is xenon or amixture of xenon and helium, and the partial pressure of xenon is nomore than about 0.8 atm (0.08 MPa).

Aspect 19. The method of aspect 1, wherein said noble gas isadministered mixed with air, the air partial pressure being about 1 atm(0.1 MPa).

Aspect 20. The method of aspect 1, wherein said noble gas isadministered as part of a gas mixture comprising oxygen, the nitrogenpartial pressure in the mixture being equal to or less than about 0.8atm (0.08 MPa).

Aspect 21. The method of aspect 20, wherein said gas mixture isessentially free of nitrogen.

Aspect 22. The method of aspect 21, wherein the oxygen partial pressureis about 0.2 atm (0.02 MPa).

Aspect 23. The method of aspect 1, wherein said clinical assessment isperformed by the EULAR score.

Aspect 24. The method of aspect 1, wherein said immunological assessmentis performed by quantification of levels of inflammatory markers.

Aspect 25. The method of aspect 24, wherein said inflammatory marker isCRP.

Aspect 26. The method of aspect 24, wherein said inflammatory marker isIL-1.

Aspect 27. The method of aspect 24, wherein said inflammatory marker isIL-6.

Aspect 28. The method of aspect 24, wherein said inflammatory marker isIL-8.

Aspect 29. The method of aspect 24, wherein said inflammatory marker isIL-17.

Aspect 30. The method of aspect 24, wherein said inflammatory marker isTNF-alpha.

Aspect 31. The method of aspect 24, wherein said inflammatory marker isHMGB-1.

Aspect 32. The method of aspect 24, wherein said inflammatory marker isIL-33.

Aspect 33. A method increasing sensitivity to an anti-cytokine biologicin a rheumatoid arthritis patient, said method comprising administrationof a Noble gas containing mixture.

Aspect 34. A method of inducing antigen specific tolerance, said methodcomprising generation of a particle containing a Noble gas together withan antigen to which tolerance is desired.

Aspect 35. A method of reducing pain in a patient with rheumatoidarthritis comprising administration of a therapeutically sufficientconcentration and frequency of a Noble gas.

DETAILED DESCRIPTION OF THE INVENTION

The invention teaches the counterintuitive findings that xenonadministration induces an increase in anti-inflammatory/immunemodulatory processes that are useful in the treatment of, and/oramelioration of rheumatoid arthritis. Rheumatoid arthritis (RA) is anautoimmune condition characterized by adaptive immune autoreactivityleading to chronic inflammation of the synovium and the presence ofrheumatoid arthritis synovial fibroblasts (RASFs) that undergohyperplasia and invade cartilage and bone [1]. RASFs exhibit anincreased ability to enter into the cell cycle, resulting in hyperplasia[2], and also show a decreased ability to undergo apoptosis [3]. RASFsproduce proinflammatory cytokines, such as IL-1 and TNF-α which providefurther stimulation for the ongoing inflammation [4]. Furthermore,enzymes including stromelysin and collagenase are produced and arecapable of invading cartilage and bone [5].

Clinically, RA affects approximately 0.5-1% of the global population [6]with varying degrees of severity. The typical treatment algorithminvolves initiation of NSAIDS, however more recent practice has beenconcurrent initiation of disease modifying antirheumatic drugs (DMARDs).These agents are slow acting but have been demonstrated to inhibitradiological progression of RA. Such agents typically include: 1)hydroxychloroquine, which acts in part as a toll like receptor (TLR) 7/9antagonist, thus decreasing innate immune activation [7]; 2)Leflunomide, an antimetabolite that inhibits pyrimidine synthesis andprotein tyrosine kinase activity [8], which results in suppression of Tcell responses [9], and has been also demonstrated to inhibit dendriticcell (DC) activation [10]; 3) Injectable gold compounds such asauranofin which directly or through metabolites such as dicyanogold (i)have been demonstrated to inhibit T cell and antigen presenting cellactivation [11, 12], as well as cause Th2 deviation [13]; 4)Sulfasalazine, was used since 1950, acts primarily through inhibition ofcycloxygenase and lipoxygenase [14]; and 5) Methotrexate, an antifolatethat inhibits T cell activation and proliferation, that has been one ofthe golden standards for RA [15]. Typically combinations of DMARDs withglucocorticoids are used, or alternatively pulse of high doseglucocorticoids are administered to cause a general inhibition ofinflammation [16].

The field of RA therapy has been revolutionized by the introduction ofthe TNF-targeting agents, Remicade, Enbrel, and Humira, sometimesreferred to as “biological DMARDs.” These are implemented primarilyafter response to conventional DMARDs has failed [17]. Althoughimprovement in quality of life has occurred as a result of biologicalDMARDs, substantial progress remains to be made. For example, TNF-alphablockers have been associated with reactivation of infectious disease,autoantibody formation and the possibility of increased lymphoma risk[18, 19]. Thus to date, one of the major limitations to RA therapy hasbeen lack of ability to specifically inhibit autoreactive responseswhile allowing other immune components to remain intact.

An “autoimmune disease” herein is any non-malignant disease or disorderarising from antibodies that are produced directed against anindividual's own (self) antigens and/or tissues.

“Immunosuppressive drugs” are any molecules that interfere with theimmune system and blunt its response to foreign or self antigens.Cyclophosphamide (CYC) and mycophenolate mofetil (MMF) are two suchkinds of molecules. This term is intended to encompass any drug ormolecule useful as a therapeutic agent in downregulating the immunesystem. This method particularly contemplates drugs that have been usedto treat autoimmune diseases such as rheumatoid arthritis, juvenilerheumatoid arthritis, systemic lupus erythematosus (SLE), lupusnephritis (LN), Wegener's disease, inflammatory bowel disease,idiopathic thrombocytopenic purpura (ITP), thrombotic throbocytopenicpurpura (TTP), autoimmune thrombocytopenia, multiple sclerosis,psoriasis, IgA nephropathy, IgM polyneuropathies, myasthenia gravis,vasculitis, diabetes mellitus, Reynaud's syndrome, Sjorgen's syndromeand glomerulonephritis.

Antibody “effector functions” refer to those biological activitiesattributable to the Fc region (a native sequence Fc region or amino acidsequence variant Fc region) of an antibody, and vary with the antibodyisotype. Examples of antibody effector functions include: Clq bindingand complement dependent cytotoxicity; Fc receptor binding;antibody-dependent cell-mediated cytotoxicity (ADCC); phagocytosis; downregulation of cell surface receptors (e.g. B cell receptor); and B cellactivation.

“Antibody-dependent cell-mediated cytotoxicity” or “ADCC” refers to aform of cytotoxicity in which secreted Ig bound onto Fc receptors (FcRs)present on certain cytotoxic cells (e.g. Natural Killer (NK) cells,neutrophils, and macrophages) enable these cytotoxic effector cells tobind specifically to an antigen-bearing-target cell and subsequentlykill the-target cell with cytotoxins. The antibodies-“arm” the cytotoxiccells and are absolutely required for such killing. The primary cellsfor mediating ADCC, NK cells, express Fc.gamma.RIII only, whereasmonocytes express FcyRT, FcyRII and FcyRIII FcR expression onhematopoietic cells is summarized in Table 3 on page 464 of Ravetch andKinet, Ann. Rev. Immunol 9: 457-92 (1991). To assess ADCC activity of amolecule of interest, an in vitro ADCC assay, such as that described inU.S. Pat. Nos. 5,500,362 or 5,821,337 may be performed. Useful effectorcells for such assays include peripheral blood mononuclear cells (PBMC)and Natural Killer (NK) cells. Alternatively, or additionally, ADCCactivity of the molecule of interest may be assessed in vivo, e.g., in aanimal model such as that disclosed in Clynes et al. PNAS (USA) 95:652-656 (1998).

“Complement dependent cytotoxicity” or “CDC” refers to the lysis of atarget cell in the presence of complement. Activation of the classicalcomplement pathway is initiated by the binding of the first component ofthe complement system (Clq) to antibodies (of the appropriate subclass)which are bound to their cognate antigen. To assess complementactivation, a CDC assay, e.g. as described in Gazzano-Santoroetal., J.Immunol. Methods 202: 163 (1996), may be performed.

The term “anti-inflammatory agent” as used herein, refers to anycompound having known effectiveness to reduce symptoms of inflammation.For example, reduction in symptoms may include, but are not limited to,reduced swelling, redness and/or local lymphocyte levels. For example,an anti-inflammatory agent may include, but is not limited to, aspirin,acetominophen, ibuprofen, cortiocosterone, or cortisol.

The terms “reduce,” “inhibit,” “diminish,” “suppress,” “decrease,”“prevent” and grammatical equivalents (including “lower,” “smaller,”etc.) when in reference to the expression of any symptom in an untreatedsubject relative to a treated subject, mean that the quantity and/ormagnitude of the symptoms in the treated subject is lower than in theuntreated subject by any amount that is recognized as clinicallyrelevant by any medically trained personnel. In one embodiment, thequantity and/or magnitude of the symptoms in the treated subject is atleast 10% lower than, at least 25% lower than, at least 50% lower than,at least 75% lower than, and/or at least 90% lower than the quantityand/or magnitude of the symptoms in the untreated subject.

The term “drug”, “agent” or “compound” as used herein, refers to anypharmacologically active substance capable of being administered whichachieves a desired effect. Drugs or compounds can be synthetic ornaturally occurring, non-peptide, proteins or peptides,oligonucleotides, or nucleotides (DNA and/or RNA), polysaccharides orsugars.

The term “administered” or “administering”, as used herein, refers toany method of providing a composition to a patient such that thecomposition has its intended effect on the patient. For example, onemethod of administering is by an indirect mechanism using a medicaldevice such as, but not limited to a catheter, applicator gun, syringeetc. A second exemplary method of administering is by a direct mechanismsuch as, local tissue administration (i.e., for example, extravascularplacement), oral ingestion, transdermal patch, topical, inhalation,suppository etc.

The term “patient”, as used herein, is a human or animal and need not behospitalized. For example, out-patients, and persons in nursing homesare “patients.” A patient may comprise any age of a human or non-humananimal and therefore includes both adult and juveniles (i.e., children).It is not intended that the term “patient” connote a need for medicaltreatment, therefore, a patient may voluntarily or involuntarily be partof experimentation whether clinical or in support of basic sciencestudies.

The term “pharmaceutically” or “pharmacologically acceptable”, as usedherein, refer to molecular entities and compositions that do not produceadverse, allergic, or other untoward reactions when administered to ananimal or a human.

The term, “pharmaceutically acceptable carrier”, as used herein,includes any and all solvents, or a dispersion medium including, but notlimited to, water, ethanol, polyol (for example, glycerol, propyleneglycol, and liquid polyethylene glycol, and the like), suitable mixturesthereof, and vegetable oils, coatings, isotonic and absorption delayingagents, liposome, commercially available cleansers, and the like.Supplementary bioactive ingredients also can be incorporated into suchcarriers.

The term “biologically active” refers to any molecule having structural,regulatory or biochemical functions. For example, biological activitymay be determined, for example, by restoration of wild-type growth incells lacking protein activity. Cells lacking protein activity may beproduced by many methods (i.e., for example, point mutation andframe-shift mutation). Complementation is achieved by transfecting cellswhich lack protein activity with an expression vector which expressesthe protein, a derivative thereof, or a portion thereof.

In one aspect of the invention, Noble gas mixtures are administered totreat autoimmunity. Further, it is preferable if the autoimmune diseaseis selected from the group consisting of: type I diabetes mellitus,rheumatoid arthritis, multiple sclerosis, chronic gastritis, Crohn'sdisease, Basedow disease, Bechterew disease, psoriasis, myastheniagravis, autoimmune hepatitis, APECED, Chrug-Strauss syndrome, ulcerativecolitis, glomerulonephritis, Guillain-Barre syndrome, Hashimotothyroiditis, lichen sclerosus, systemic lupus erythematosis, PANDAS,rheumatic fever, sarcoidosis, Sjogren syndrome, Stiff-Man syndrome,scleroderma, Wegener's granulomatosis, vitiligo, Wegener's disease,inflammatory bowel disease, idiopathic thrombocytopenic purpura (ITP),thrombotic throbocytopenic purpura (TTP), autoimmune thrombocytopenia,multiple sclerosis, psoriasis, IgA nephropathy, IgM polyneuropathies,myasthenia gravis, vasculitis, diabetes mellitus, Reynaud's syndrome,Sjorgen's syndrome and glomerulonephritis, autoimmune enteropathy,Goodpasture syndrome, dermatomyositis, polymyositis, autoimmune allergy,asthma and autoimmune reaction after organ transplantations.

Amounts effective will depend, of course, on the particular subjectbeing treated; the severity of a condition, disease or disorder; theindividual patient parameters including age, physical condition, sizeand weight; the duration of the treatment; the nature of concurrenttherapy (if any); the specific route of administration and like factorswithin the knowledge and expertise of the health practitioner. Thesefactors are well known to those of ordinary skill in the art and can beaddressed with no more than routine experimentation. It is generallypreferred that a maximum dose be used, that is, the highest safe doseaccording to sound medical judgment. It will be understood by those ofordinary skill in the art, however, that a patient may insist upon alower dose or tolerable dose for medical reasons, psychological reasonsor for virtually any other reason.

In one embodiment of the invention, patients suffering from RA areadministered xenon at a concentration of 25% xenon in 75% air. Variousconcentrations may be performed and adjusted based on immunological andclinical responses. In a preferred embodiment administration of xenon isperformed 3 times per week in a volume of 10 liters, with aconcentration of 25% xenon and 75% air. Other gases such as argon,helium, neon and krypton may be utilized. Additionally, other excipientsmay be added to alter immunological parameters. In order to guide ofskill in the art in the practice of the invention, a table of some ofthe immunological intervention clinical trials for RA is provided below.This table may serve to guide a practitioner of the invention inchoosing immunological and clinical parameters for assessment.

Phase I/II Studies in RA Number of Experimental Patients Drug EndpointsReference 20 Antibody to TNF- Safety, morning stiffness, VAS pain scale,[20] alpha number of swollen joints, 5 point symptom scale, HealthAssessment Questionnaire, Richie articular index 30 Antibody to IL-15Safety, tender joint count, swollen joint count, [21] early morningstiffness, pain score (visual analog scale), patient global assessment,physician global assessment, Health Assessment Questionnaire, AmericanCollege of Rheumatology Response Score 8 Autologous stem Safety, swollenjoint count, duration of morning [22] cell and stiffness (in minutes),pain score using a 100- cyclophosphamide mm visual analog scale (VAS),disability section of the Health Assessment Questionnaire 24 Anti-CD4Safety, American College of Rheumatology [23] antibody Response Score,RA-specific Health Assessment Questionnaire 16 Oral CCR1 28 joint countfor joint swelling and tenderness, [24] antagonist doctor's andpatient's assessment of disease activity on a scale from 1(asymptomatic) to 5 (severe symptoms), pain assessed by a visualanalogue scale from 0 (no pain) to 100 (severe pain), quality of life(Health Assessment Questionnaire (HAQ)) from 0 (no disability) to 3(severe disability)

For monitoring RA disease activity for this rheumatoid arthritis trial,a 28-joint count for tenderness and swelling is employed. To assess thetender joint count, the examiner documents which joints the patientindicates are painful on palpation with enough pressure to blanch thenail bed of the examiner's thumb and index fingers. To assess theswollen joint count, the examiner documents which joints have palpablesoft tissue swelling or fluctuance, excluding joints affected only bydeformity or bony hypertrophy. The 28-joint count includes theshoulders, elbows, wrists, first to fifth metacarpophalangeal joints,first to fifth proximal interphalangeal joints, and knees on both sidesof the body. Compared to more extensive joint counts, the 28-joint counthas the advantage of being quick and easy to perform; however, it islimited by the fact that the ankles and metatarsophalangeal joints arenot included, so active disease in the feet may be underestimated. The28-joint count is used to calculate the disease activity score 28(DAS28), which is a validated instrument to monitor disease activity.

This is performed as follows:

1. Perform a swollen and tender joint examination of your patient,noting each affected joint on Form A. When complete, add all of theswollen and tender joints and record the totals in the appropriate boxeson Form B.

2. Obtain and record the patient's erythrocyte sedimentation rate (ESR)in mm/h in the appropriate box on Form B. Note: C-reactive protein (CRP)levels may be used as a substitute for an ESR.

3. Obtain and record the patient's general health on a Visual AnalogScale (VAS) of 100 mm in the appropriate box on Form B. Note: DAS28calculations may be performed without a VAS measurement.

4. Plug the appropriate values into the formula: DAS28=0.56*√{squareroot over ( )}(tender joints)+0.28*√{square root over ( )}(swollenjoints)+0.70*Ln(ESR/CRP)+0.014*VAS

5. A DAS28 score of higher than 5.1 is indicative of high diseaseactivity, whereas a DAS28 below 3.2 indicates low disease activity. Apatient is considered to be in remission if they have a DAS28 lower than2.6.

Left Right Swollen Tender Swollen Tender FORM A Shoulder Elbow WristMetacarpophalangeal (MCP) 1 2 3 4 5 Proximal Interphalangeal (PIP) 1 2 34 5 Knee Subtotal TOTAL Total Swollen: Total Tender: FORM B Swollen(0-28) Tender (0-28) ESR (or CRP) VAS disease activity (0-100 mm)

The EULAR response criteria include not only change in disease activitybut also current disease activity. To be classified as responders,patients should have a significant change in DAS and also low currentdisease activity. Three categories are defined: good, moderate, andnon-responders. EULAR response criteria combine the DAS28 score at thetime of evaluation with the change in DAS28 score between two timepoints, and enable the user to define improvement or response totreatment. The thresholds for low disease activity and remission and theEULAR response criteria provide a standardised guide on how to interpretthe DAS28 scores

The HAQ was developed as a comprehensive measure of outcome in patientswith a wide variety of rheumatic diseases, including rheumatoidarthritis, osteoarthritis, juvenile rheumatoid arthritis, lupus,scleroderma, ankylosing spondylitis, fibromyalgia, and psoriaticarthritis. It has also been applied to patients with HIV/AIDS and instudies of normal aging. It should be considered a generic rather than adisease-specific instrument. Its focus is on self-reportedpatient-oriented outcome measures, rather than process measures.

Thus, in one embodiment of the invention, therapeutic Noble Gascompositions are administered in a manner to alter immunological factorsin the body. Specifically, the invention teaches that variousconcentrations of xenon gas, when delivered into circulation, either byinhalation [25-27], or administration of echogenic xenon liposomes [28,29], can be utilized to induce a T regulatory cell phenotype andsuppression of Th17 or other arthritogenic cells. The use of xenon hasbeen reviewed by numerous authors in the art, which provide guidance asto details of administration [30-32]. Importantly, the new andnon-obvious aspect of the current invention is that xenon, as well asother Noble gases, are capable of inducing immune modulation to inhibitautoimmunity, as well as to inhibit pain associated with RA.

Examples of gases or gas mixtures employed as medicament for radiationprotection: 1.) 100% by volume xenon; 2.) 70% by volume xenon/30% byvolume oxygen; 3.) 65% by volume xenon/30% by volume oxygen/5% by volumenitrogen; 4.) 65% by volume xenon/35% by volume oxygen; 5.) 60% byvolume xenon/30% by volume oxygen/10% by volume nitrogen; 6.) 60% byvolume xenon/35% by volume oxygen/5% by volume nitrogen; 7.) 60% byvolume xenon/40% by volume oxygen; 8.) 55% by volume xenon/25% by volumeoxygen/20% by volume nitrogen; 9.) 55% by volume xenon/30% by volumeoxygen/15% by volume nitrogen; 10.) 55% by volume xenon/35% by volumeoxygen/10% by volume nitrogen; 11.) 55% by volume xenon/40% by volumeoxygen/5% by volume nitrogen; 12.) 55% by volume xenon/45% by volumeoxygen; 13.) 50% by volume xenon/50% by volume oxygen; 14.) 50% byvolume xenon/45% by volume oxygen/5% by volume nitrogen; 15.) 50% byvolume xenon/40% by volume oxygen/10% by volume nitrogen; 16.) 50% byvolume xenon/30% by volume oxygen/20% by volume nitrogen; 17.) 50% byvolume xenon/25% by volume oxygen/25% by volume nitrogen; 18.) 45% byvolume xenon/55% by volume oxygen; 19.) 45% by volume xenon/50% byvolume oxygen/5% by volume nitrogen; 20.) 45% by volume xenon/45% byvolume oxygen/10% by volume nitrogen; 21.) 45% by volume xenon/40% byvolume oxygen/15% by volume nitrogen; 22.) 45% by volume xenon/35% byvolume oxygen/20% by volume nitrogen; 23.) 45% by volume xenon/30% byvolume oxygen/25% by volume nitrogen; 24.) 45% by volume xenon/30% byvolume oxygen/25% by volume nitrogen; 25.) 40% by volume xenon/30% byvolume oxygen/30% by volume nitrogen; 26.) 40% by volume xenon/50% byvolume oxygen/10% by volume nitrogen; 27.) 35% by volume xenon/25% byvolume oxygen/40% by volume nitrogen; 28.) 35% by volume xenon/65% byvolume oxygen; 29.) 30% by volume xenon/70% by volume oxygen; 30.) 30%by volume xenon/50% by volume oxygen/20% by volume nitrogen; 31.) 30% byvolume xenon/30% by volume oxygen/40% by volume nitrogen; 32.) 20% byvolume xenon/80% by volume oxygen; 33.) 20% by volume xenon/30% byvolume oxygen/50% by volume nitrogen; 34.) 15% by volume xenon/30% byvolume oxygen/55% by volume nitrogen; 35.) 15% by volume xenon/50% byvolume oxygen/35% by volume nitrogen; 36.) 10% by volume xenon/90% byvolume oxygen; 37.) 10% by volume xenon/50% by volume oxygen/40% byvolume nitrogen; 38.) 10% by volume xenon/30% by volume oxygen/60% byvolume nitrogen; 39.) 10% by volume xenon/25% by volume oxygen/65% byvolume nitrogen; 40.) 5% by volume xenon/25% by volume oxygen/70% byvolume nitrogen; 41.) 5% by volume xenon/30% by volume oxygen/65% byvolume nitrogen; 42.) 5% by volume xenon/50% by volume oxygen/45% byvolume nitrogen; 43.) 5% by volume xenon/30% by volume oxygen/65% byvolume nitrogen; 44.) 5% by volume xenon/95% by volume oxygen; 45.) 1%by volume xenon/99% by volume oxygen; 46.) 1% by volume xenon/30% byvolume oxygen/69% by volume nitrogen; 47.) 1% by volume xenon/25% byvolume oxygen/74% by volume nitrogen.

In an expanded use of the invention, a wider variety of autoimmuneconditions may be treated, said conditions may be treated by said Noblegas containing compositions, or may be treated by combinations withexisting immune modulator drugs and Noble gas containing compositions.In a more selected manner, the invention may be utilized byadministration of antigen-specific tolerogenic vaccines with said Noblegas containing compositions. Autoimmune diseases include refers to anydisease or disorder in which an immune response is generated in responseto a substance, such as a protein or a tissue, that is normally presentin the body and such response is undesirable. Generally, such a diseaseor disorder includes undesired immune responses to one or more selfantigens. Autoimmune disease and autoimmune disorder may be usedinterchangeably through the disclosure and are considered to besynonymous. The list of autoimmune diseases may include, but is notlimited to, multiple sclerosis, rheumatoid arthritis, type 1 diabetes,Crohns disease, ulcerative colitis, psoriasis, etc. Autoimmune diseasesmay also include diseases induced by foreign antigens, such as celiacdisease. Non-limiting examples of autoimmune diseases also include Acutedisseminated encephalomyelitis (ADEM), Addison's disease,Agammaglobulinemia, Alopecia areata, Amyotrophic lateral sclerosis,Ankylosing Spondylitis, Antiphospholipid syndrome, Antisynthetasesyndrome, Atopic allergy, Atopic dermatitis, Autoimmune aplastic anemia,Autoimmune cardiomyopathy, Autoimmune enteropathy, Autoimmune hemolyticanemia, Autoimmune hepatitis, Autoimmune inner ear disease, Autoimmunelymphoproliferative syndrome, Autoimmune peripheral neuropathy,Autoimmune pancreatitis, Autoimmune polyendocrine syndrome, Autoimmuneprogesterone dermatitis, Autoimmune thrombocytopenic purpura, Autoimmuneuveitis, Behcet's disease, Celiac disease, Cold agglutinin disease,Crohn's disease, Dermatomyositis, Dermatomyositis, Diabetes mellitustype 1, Eosinophilic fasciitis, Goodpasture's syndrome, Graves' disease,Guillain-Barre syndrome (GB S), Hashimoto's encephalopathy, Hashimoto'sthyroiditis, Idiopathic thrombocytopenic purpura, Lupus erythematosus,Miller-Fisher syndrome, Mixed connective tissue disease, Multiplesclerosis, Myasthenia gravis, Narcolepsy, Pemphigus vulgaris, Perniciousanaemia, Polymyositis Primary biliary cirrhosis, Psoriasis, Psoriaticarthritis, Relapsing polychondritis, Rheumatoid arthritis, Rheumaticfever, Sjogren's syndrome, Temporal arteritis, Transverse myelitis,Ulcerative colitis, Undifferentiated connective tissue disease,Vasculitis, and Wegener's granulomatosis. In some embodiments, theautoimmune disease is Multiple Sclerosis (MS). Generally, the autoimmunedisease or disorder is T-cell-mediated.

Example: Treatment of 20 DMARD-Resistant RA Patients with Xenon

20 patients with disease modifying antirheumatic drug (DMARD)-resistantRheumatoid Arthritis (RA) are chosen for a clinical trial assessingsafety and efficacy of 25% Xenon administration with 75% air. A total of10 liters of gas inhaled. Administration is performed 3 times per week.

The number of 20 patients has been chosen based on previous clinicaltrials aiming to identify a signal of efficacy with demonstration offeasibility and safety [20-24].

Safety is determined by assessment of hematological biochemical, andcoagulation parameters on baseline, and days 30, 60, and 90. Efficacy isassessed by CRP, ESR, anti-citrulline antibody, RF, Quality of LifeQuestionnaire, 28-joint disease activity score (DAS28), European Leagueagainst Rheumatism (EULAR) response criteria and immunologicalparameters.

Men and women at least 18 years of age are eligible to participate ifthey meet the American College of Rheumatology (ACR) criteria for RA forat least one year and are in functional Class I, II, or III [33]. Allpatients will have to have had at least one failed trial of a DMARD andmust have at least 10 painful and 10 swollen joints at entry. No DMARDtherapy is allowed within 4 weeks of study entry. Patients receivingnonsteroidal anti-inflammatory drugs, corticosteroids (<10 mg per day),or both will be allowed in the trial if they have been on stable dosesfor at least four weeks before study entry. Required baseline laboratoryvalues include serum creatinine and blood urea nitrogen <1.5× the upperlimit of normal and alanine aminotranferase and aspartateaminotransferase <2.0× the upper limit of normal. Exclusionarylaboratory values include a platelet count of >500,000/mm3, hematocrit<30%, and a white-blood-cell count <3000/mm3. Other exclusionarycriteria include history of cancer, use of intravenous or intraarticularcorticosteroids within four weeks of randomization, any prior use ofcyclosporine or cyclophosphamide, use of any investigational agentwithin 30 days of study entry, severe extra-articular manifestations ofRA, acute infection requiring antibiotic therapy within two weeks ofstudy entry, other concurrent autoimmune disease (e.g. systemic lupuserythematosus), or any other condition that the investigator thoughtmight have placed the patient at undue risk if they had participated inthe trial. Men and women of childbearing potential are to use approvedmethods of birth control. Women have to have a negative result on a testof serum beta human chorionic gonadotropin at screening. Medicationsincluding cyclosporine, cyclophosphamide, and any DMARD will notallowed. The use of intravenous or intraarticular corticosteroids willnot be permitted. The following analgesics are permitted: acetaminophen,acetaminophen with codeine, acetaminophen with oxycodone, andpropoxyphene. Patients will be instructed not to take analgesics within12 hours of their planned study visit.

The primary objective of this feasibility study is to provide clinicaldata to demonstrate the safety and efficacy of xenon administration 10liters at 25% xenon, 3 times per week for the duration of the trial intreating patients diagnosed with DMARD-resistant rheumatoid arthritis(RA).

The secondary objectives are to demonstrate that xenon administrationimpacts the clinical course of RA resistant to DMARDS as measured by QOLquestionnaire, 28 joint DAS and EULAR criteria, and to assess the effectof the xenon therapy on immunological/inflammatory parameters includingCRP, RF, anti-citrulinated antibodies.

Safety will be assessed throughout the study with the use of directevaluation and patient reporting during study visits orpatient-initiated telephone contacts. The types, frequencies, severity,and duration of any reported adverse event or abnormalities in clinicallaboratory values, physical examinations, vital signs, or specialcardiovascular evaluations will be assessed. The changes from baselinewill be summarized.

Safety data to be summarized include by not limited to:

Adverse Events/Serious Adverse Events

Complete blood count

Physical assessment/vital signs

ECG

To assess preliminary evidence of efficacy, the following assessmentswill be analyzed at following time points and compared to baselinevalues:

Disease Severity at 1, 2, and 3 Months:

Changes in 28-joint disease activity score (DAS28)

Changes in European League against Rheumatism (EULAR) response criteria

Reduction in RF, ESR, CRP and anti-citrulinated fibrinogen antibody

Quality of Life Assessment at 1, 2, and 3 Months Measured by:

Change in Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire

Subsequent to therapy, patients demonstrate no significant treatmentassociated adverse events and reduction of clinical and immunologicalparameters of RA is noted in a statistically significant manner.

1. A method of alleviating pain in a patient suffering from anautoimmune disease comprising the steps of: a) identifying a patientsuffering from pain associated with an autoimmune disease b) providingto said patient a noble gas composition comprising between 25-30% xenonand 70-75% air or oxygen by total volume of the noble gas composition inan amount sufficient to alleviate the pain.
 2. The method of claim 1,wherein said noble gas composition containing mixture consistsessentially only of: a) oxygen and xenon or b) air and xenon.
 3. Themethod of claim 1, wherein said noble gas composition further comprisescontaining mixture also contains a gas selected from the groupconsisting of: nitrogen, helium, nitric oxide, krypton, argon and neon.4. The method of claim 1, wherein said identification and alleviation ofsaid pain is determined using a visual analog scale.
 5. A method ofincreasing sensitivity to an anti-cytokine biologic treatment in apatient suffering from an autoimmune disease, comprising: identifying apatient suffering from an autoimmune disease; and providing to saidpatient a noble gas composition comprising between 25-30% xenon and70-75% air or oxygen by total volume of the noble gas composition in anamount sufficient to increase sensitivity to said anti-cytokine biologictreatment.
 6. A method of inducing antigen specific tolerance patientsuffering from an autoimmune disease, comprising: identifying a patientsuffering from an autoimmune disease, and having an intolerance to anantigen; and providing to said patient a noble gas compositioncomprising between 25-30% xenon and 70-75% air or oxygen by total volumeof the noble gas composition in an amount sufficient to induce toleranceto said antigen.